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Lord Skelmersdale: Before my noble friend the Minister pours what I hope will be very icy water indeed on this amendment, I would like to respond to something which the noble Lord, Lord Carter, said. As he knows very well, the reforms have been discussed in the health service since about 1985. The year 1990 was the tip of a particular iceberg in that discussion. The moment the 1990 Bill was published the discussion within the health service immediately turned to how much longer shall we keep the regional authorities.
Lord Carter: Perhaps I may respond to that. I believe that the noble Lord is wrong. The reforms started on a "Panorama" programme when the previous Prime Minister, Mrs. Thatcher, was asked what the Government were going to do about the health service. She said that they were going to reform it. That was a surprise to her Ministers and, I believe, in particular to the Minister, Mr. Kenneth Clarke, who took over the job and found, I am told, a blank sheet of paper. The idea that these measures are a seamless robe that started in 1985 and proceeded smoothly along the way, is not so.
The only point that I was making, in response to the noble Baroness, Lady Gardner, was that it is not correct to say that this was thought of in 1990. If that had been the case, the provisions would have been included in the Act which we spent a great deal of time discussing.
Lord Skelmersdale: and it was my then right honourable friend, who is now the noble Lord, Lord Moore, who instigated the reforms. My right honourable friend the current Chancellor certainly did not come into office with a blank sheet of paper.
Baroness Cumberlege: I am very tempted to enter the debate on correcting the history of this matter because I was party to many of the discussions that took place at that time; but I do not think that this is quite the moment to go into that. I take on board the views of my noble friend Lord Peyton that we need to get on with the job. Perhaps we should think of the phrase, "God make speed to save us".
My noble friends Lord Elton, Lord Carr, Lord Peyton and Lord Skelmersdale were right to remind the Committee that we have already agreed the principle of the Bill at Second Reading. I made clear during that debate that one of the two purposes of the Bill is the abolition of regional health authorities. Indeed, the Long Title of the Bill makes that clear. This is a Bill to abolish regional health authorities, district health authorities and family health services authorities, and require the setting up of new health authorities. As my noble friends Lord Carr and Lord Peyton have said, that leaves many details for us to discuss; but whether to abolish RHAs is not one of them.
Perhaps I may remind your Lordships why the Government have proposed the abolition of RHAs. We do not deny that RHAs played a necessary and important role in the NHS before the 1990 reforms. Their management skills were vital, not least in hands-on management of hospitals and in directing DHAs, and they carried out useful operation and co-ordinating tasks.
The regional health authorities were crucial in the first stages of the reforms. Their valuable experience and support were needed to ensure the successful development of NHS trusts, of GP fundholders and of purchasing district health authorities. Systems of management had to be built up at a local level, and RHA expertise was needed here. But as my noble friend Lady Gardner said, responsibility has now been successfully devolved from RHAs closer to patients. I am grateful to my noble friend Lord Carr for highlighting the success of GP fundholders and NHS trusts. The development of stronger local purchasing authorities has changed the way the NHS should be managed in the future. There are fewer purchasing authorities than there once were because of authority mergers. After this Bill there will be fewer stillonly around 100 in totalso large organisations will not be needed at regional level to manage them.
I do not deny that regional co-ordination will still be vital after the reorganisation. We are not proposing to move all RHA functions to health authoritiesthat is why the regional offices have been established. The NHS executive headquarters and the regional offices will contribute to health policy across the country and to developing the overall strategic direction of the NHS: for example, they will develop and evaluate the overall NHS research and development strategy, which has been mentioned this afternoon. Perhaps I may reassure the noble Baronesses, Lady Jay and Lady Robson, and the noble Lord, Lord Walton, in absentia, that strategic planning for specialised services such as neurosurgery must of course still be performed at regional level. Health authority areas will be too small for planning such servicesso they will be achieved through consortia of health authorities. These will be supported, particularly in the early stages, by the regional offices. They will not be expected to devolve functions to purchasers if they do not have confidence that they are capable of maintaining high standards.
But the need for a regional management structure does not mean that the size and bureaucratic complexity of the RHAs is still needed. Regional strategic management must be administered with a light touch, respecting the freedoms of both purchasers and providers. The effectiveness of the National Health Service Management Executive regional outposts, which had only 10 to 15 staff each to manage all the NHS trusts in the region, has shown that this new approach can be successful in the NHS.
Your Lordships have expressed doubts about the accountability of the regional offices. Perhaps I can try to reassure the noble Lord, Lord Stoddart of Swindon, and other Members of the Committee that the move from RHAs to regional offices, which are part of the Civil Service, is a logical step. The role of the regional offices is best carried out as part of the department, in direct line to the Secretary of state. They will not be taking the key decisions which will directly affect local people. The new, stronger health authorities will be taking those decisions, and they will be "independent" and "accountable" in the same way as RHAs. Regional offices will have new opportunities to influence policy by offering advice to Ministers. It is entirely appropriate this should be the province of members of the Civil Service, and the regional offices will of course be accountable to Parliament through the Secretary of State, just like the rest of the department.
Because regional offices will be part of the department, it will be easier to ensure that they remain small and streamlined. Had we replaced RHAs with separate statutory authorities, there would be a risk of building up again the bureaucracy we are committed to removing. With regional offices firmly part of the department, we can reduce duplication of work between the NHS executive and regions. In the past, there has been overlap in areas like performance management, guidance and interpretation of policy, checking of statistics, and so on. Most things will be done in the future either by regional offices or by the executive headquarters as part of the same organisation. There will be no need for them to double-check each other. This will lead to savings.
The noble Lord, Lord Stoddart, asked about redundancies in the National Health Service due to the changes. Perhaps I can refer to the efforts that have already been made by the regional health authorities. Of course, there will inevitably be costs associated with redundancies. We accept that; but we shall try to minimise the numbers as much as possible. The regional health authorities are making every effort to minimise the disruption to staff, using measures such as voluntary redundancies, clearing house arrangements, out-placements and retraining schemes. Where it is necessary to make staff redundant, they will receive the full financial benefits to which they are entitled. I pick up the points made by my noble friends Lord Carr and Lord Peyton that we need to get on with the business. That is particularly true in the context of staff because nothing is more demoralising than not knowing where one's future lies.
The new health authorities will be well placed to take on functions currently discharged by RHAs. Functions can be delegated to the lowest sensible levelcloser to patients, so that decisions can be taken quickly in response to changes in need.
The noble Baroness, Lady Jay, expressed concern about the move of the regional directors of public health from RHAs to regional offices. But the role of the regional directors of public health will be different in the new system. Most public health functions will be carried out by the new health authorities. They will be a much more appropriate place for public health issues than the RHAs, which are artificial entities in public health terms. District directors of public health will report on the health of their local populations and will be free to comment on the factors affecting health care in their area. The role of the regional director will be to ensure that health authorities carry out their public health role effectively. Those responsibilities will be entirely appropriate to their status as civil servants.
The noble Lord, Lord Rea, asked about post-graduate deans and regional GP advisers. I am pleased to tell the noble Lord that we have today published a full consultation document which will be placed in the Library tomorrow. I believe that that will answer many of the noble Lord's misgivings and concerns.
To conclude: it is the new health authorities which will take responsibility for the public health of their populations, for planning services, for assessing health needs. They will develop an effective, primary care-led NHS. The retention of regional health authorities is not necessary for this and could well get in the way. Their abolition will save money to be reinvested in patient care. There will be savings of around £150 million per year when the Bill is fully implemented, and the bulk of this will come from the abolition of RHAs, the cutting of bureaucracy and the reduction in duplicating work. I invite your Lordships to reject the amendment.
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